Uterus Removal, Abdominal (Hysterectomy)

What is an abdominal hysterectomy?

An abdominal hysterectomy is a procedure in which the uterus is removed through a cut in the abdomen. The uterus is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus.

Other female organs may also be removed when the uterus is removed.

• A radical hysterectomy is the removal of the uterus (womb), cervix, ovaries, fallopian tubes, and pelvic lymph nodes.
• A total hysterectomy is the removal of the uterus and the cervix, but not the ovaries or tubes.
• A subtotal hysterectomy is the removal of the uterus, but the ovaries, cervix, and fallopian tubes are left in place.

When is it used?

There are many reasons why you and your healthcare provider may decide to take out your uterus. Some of the problems that may be treated with a hysterectomy are:

• tumors in the uterus
• constant heavy bleeding that has not been controlled with medicine or by dilatation and curettage (D&C)
• endometriosis that causes pain or bleeding and does not respond to other treatments
• chronic pelvic pain
• a fallen (sagging) uterus
• precancerous or cancerous cells or tissue on the cervix, in the uterus, or on the lining of the inside of the uterus (called the endometrium)

Examples of possible alternatives to an abdominal hysterectomy are:

• having the uterus removed through the vagina (vaginal hysterectomy)
• taking medicines to treat some types of problems
• having a hysteroscopy or laparoscopy
• continue having D&Cs to control abnormal bleeding
• treat precancerous cells of the cervix with conization (removing a cone-shaped part of the cervix)
• remove an area of endometriosis without removing the uterus
• remove tumors (fibroids) without removing the uterus
• knowing and understanding the risks of your condition, but choosing not to have treatment

You should ask your healthcare provider about these choices.

How do I prepare for an abdominal hysterectomy?

Plan for your care and recovery after the operation. Allow for time to rest. Try to find other people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should stop smoking at least 2 weeks before the procedure. It is best to stop smoking 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Be sure to tell your healthcare provider what medicines you are taking, including nonprescription drugs and herbal remedies.

Follow any instructions your provider gives you. Your provider may tell you to eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

Your provider may give you a laxative to take the night before the surgery or an enema the morning before the surgery. At the time of the surgery, your healthcare provider may shave your lower abdomen down to the top of the pelvis.

What happens during the procedure?

You will be given a regional or general anesthetic. A regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the operation. A general anesthetic relaxes your muscles and causes a deep sleep. It will prevent you from feeling pain during the procedure. During general anesthesia, a tube is usually placed in your throat to help you breathe.

Usually a catheter (small tube) is placed into your bladder through the urethra (the tube from the bladder to the outside). The catheter drains the bladder.

You will have an IV in your arm to give you fluids and medicines, including antibiotics.

The healthcare provider makes a cut in the abdominal wall to expose the ligaments and blood vessels around the uterus. The provider separates the ligaments and blood vessels from the uterus. The provider ties off the blood vessels so they will heal and not bleed. Then, the uterus is removed by cutting it off at the top of the vagina. The top of the vagina is stitched closed so that a hole is not left.

What happens after the procedure?

The IV and catheter are removed 1 or 2 days after the surgery. You may stay in the hospital about 2 to 5 days.

After you go home, get plenty of rest. Do not do any heavy lifting or otherwise strain the stomach muscles for 4 to 6 weeks. Follow your healthcare provider's instructions for dealing with pain and preventing constipation. Ask your provider what other steps you should take and when you should come back for a checkup.

If you were having menstrual periods before the surgery, you will no longer have them after the operation. You also cannot become pregnant. If your ovaries were removed, menopause starts right away. Your healthcare provider may prescribe medicine such as hormone therapy to help relieve some of the symptoms of menopause. Be sure to discuss any concerns you have about these effects and treatments with your provider before the surgery.

What are the benefits of this procedure?

A hysterectomy takes care of problems you may have been having with your uterus. For example, it removes any tumors that may have been in your uterus and it stops menstrual periods and any pain you may have been having.

What are the risks associated with this procedure?

There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.

• A regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Regional anesthesia is considered safer than general anesthesia.
• You may develop an infection and need antibiotics or more surgery.
• You may develop bleeding and need a blood transfusion.
• The cut in your abdomen (incision) may have to be reopened to stop any bleeding.
• Your bladder or the tubes leading to it may be injured and need surgical repair.
• A piece of blood clot may break off, enter your bloodstream, and block an artery in the lung.
• The incision may open.
• You may develop a hernia (weakening of the abdominal muscles, causing the intestines to push into the weakened area) in the incision.
• Your intestine (bowel) may be injured during the surgery.

Ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You develop a fever over 100°F (37.8°C).
• You become dizzy and faint.
• You have nausea and vomiting.
• You have chest pain.
• You become short of breath.
• You have heavy bleeding from the vagina.
• You have leakage from the incision or the incision opens up.
• You have pain when you urinate.
• You have swelling, redness, or pain in your leg.
• You have diarrhea that does not stop.

Call your provider during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.